The Geriatric Spine Syndrome Meets Spine Grand Rounds

By | July 3, 2011

Disc protrusions at multiple levels and a subtle spondylolisthesis at C4-5 & C5-6 combined with significant comorbidities make this case more challenging than it may at first appear.

I have been asked to present the featured case at Spine Grand Rounds and the Glendale Adventist Medical Center Spine Institute this Thursday 7 July. These rounds are a monthly gathering of some of the best spine surgeons, neuroradiologists, physiatrists and pain management physicians in the area who come together to discuss interesting and unusual cases. It is quite an honor as a non-surgeon to be asked to present the case.


I thought for some time about rare and interesting chronic pain cases I have done recently, a high cervical pump catheter to treat a brachial plexopathy or a lumbar transverse quadrapole stimulator array that has successfully treated not only the patient’s post-laminectomy syndrome but his peripheral arterial disease as well. But, everyone tends to do this, not just at Spine Grand Rounds, but at Tumor Board or Journal Club, and what you tend to end up with is a very detailed and narrowly focused discussion, which is of primary interest to only a small portion of the group. In short you end up missing the forest for the trees.


I have always been a forest type of guy and if I can’t show the whole forest of spinal pain management, I thought that by presenting a deceptively simple case of combined multilevel neck pain and back pain I could stimulate a discussion of the grove of trees I like to call the Geriatric Spine Syndrome.  But there is hidden danger in a subtle spondylolisthesis at C4-5 and C5-6 as well as significant pulmonary comorbidities waiting to ensnare the unsuspecting.  I would like to see if I can induce my hard nosed, nuts and bolts, take control surgical colleagues to discuss spine care for the elderly from a more Taoist point of view. I firmly believe that when it comes to spine care many times, less is more!


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